肝内外胆管多发结石肝部分切除术后肝功能衰竭的诊治

目的：探讨肝内外胆管多发结石术后肝功能衰竭的预防、诊断及治疗。方法：我院2011年1 月~2013 年12 月收治肝内外胆 管多发结石行手术治疗患者共126 例，术后发生肝功能衰竭者6 例，均是合并肝叶切除患者。及时准确诊断肝功能衰竭后予抗 炎、护肝、止血、输血、糖皮质激素、抑酸、人血白蛋白、利尿、降血氨、血浆置换及对症支持等治疗。结果：6 例患者出院前复查总胆 红素28.3~ 58.7 mmol/L，谷丙转氨酶16~ 62 U/L，谷草转氨酶12~ 85 U/L，血浆白蛋白32.1~ 37.8 g/L，凝血功能基本正常，腹水消 失，血氨正常，上消化道出血停止。术后12~ 35 d出院，平均18 d。6例患者术后长期随访，目前均存活。结论：肝功能衰竭是肝脏 及胆道术后最为严重的并发症之一，充分的术前准备及评估，术后的及时诊断及治疗，可明显降低其死亡率。

The Diagnosis and Treatment of Liver Failure after Hepatectomy of Bile Duct Stones

Objective:To explore the prevention, diagnosis and treatment of postoperative liver failure of the multiple stones of bile duct.Methods:FromJanuary 2011 to December 2013, a total of 126 patients with multiple stones of bile duct of liver inside and outside lines who underwent surgical treatment were hospitalized, postoperative liver failure were found in 6 cases who received merger lobe resection, accounted for 4.76%. After timely and accurate diagnosis of liver failure, the anti-inflammation protection of liver, hemostasis, human blood albumin, glucocorticoid, inhibition of gastric acid, blood transfusion, diuresis, fall blood ammonia, plasma exchange, symptomatic treatment and support treatment were given to the patients.Results:Before discharging fromhospital, the T-BIL of 6 patients was 28.3 ~ 58.7 mmol/L. ALT was 16 ~ 62 U/L, AST was 12 ~ 85 U/L, plasma albumin was 32.1 ~ 37.8 g/L, the coagulation function returned to normal, the ascites disappeared, blood ammonia was normal, upper gastrointestinal bleeding was stopped. Post operative hospitalization duration 12 ~ 35 d, an average of 18 days. All 6 patients survived in the follow-up, visit until now.Conclusion:Liver failure was one of the most serious complications of liver and biliary tract surgery, however, sufficient preoperative preparation and evaluation, timely preoperative diagnosis and treatment, could obviously reduce the mortality.